Other Infections

San Francisco would be best served by having several supervised injection sites accompanied by social services for people who use drugs, according to a report from a city task force set up to study the issue.

These sites would remain illegal under state law, however, as a bill to permit pilot safe injection facilities in 8 California counties narrowly failed in the state Senate in September.

If implemented, the task force recommendations would "provide a welcoming and integrated service system for drug users, to improve their safety and the safety of the general population, and most importantly to improve their access to health care," said San Francisco health director Barbara Garcia.

Safe injection sites offer a place to inject drugs under the watch of medical staff, cutting the risk of overdose fatalities. They provide clean syringes and other injection equipment to prevent transmission of HIV and hepatitis B and C. They also reduce street-based drug use and improper syringe disposal, and offer clients an entry point for seeking addiction treatment and medical care.

San Francisco, which has around 22,500 people who inject drugs, according to the report, is one of several cities vying to open the first supervised injection site in the United States. There are currently safe injection facilities in around 10 countries including Canada, Australia, and the Netherlands.

The task force, established by Board of Supervisors president [and now acting mayor] London Breed in May 2017, offered 17 recommendations in the report, which was presented to the board's Public Safety and Neighborhood Services Committee on October 25.

The recommendations include operating multiple sites throughout San Francisco, located in areas where drug use occurs most often and where people who inject drugs are receiving existing services, and ensuring that they serve the needs of vulnerable populations including LGBT people, homeless people, and sex workers.

"The rise in public injection drug use and its harmful public health and safety outcomes has long reached critical mass in the city," the report states. "Research consistently demonstrates that safe injection services are an evidenced-based harm reduction strategy that can address this public health issue."

A recent study by task force member Alex Kral of RTI International and colleagues estimated that a single supervised injection facility in San Francisco, similar to Vancouver's Insite, could prevent 3 new cases of HIV and 19 new cases of hepatitis C each year, save 1 life every 4 years, lead 110 people per year into addiction treatment, and save the city $3.5 million dollars annually.

"The science from other countries is clear that these sites reduce public consumption of drugs, publicly discarded injection paraphernalia, and crime and violence in the neighborhoods where they are located," Kral said. "While millions of people have used supervised consumption sites in ten countries over the past three decades, no one has ever died of an overdose at a site."

Injection Sites Remain Illegal

A bill introduced by Assemblymember Susan Talamantes Eggman (D-Stockton) and co-authored by Senator Scott Wiener (D-San Francisco) would have permitted exceptions to state controlled substances laws, allowing local governments to authorize supervised injection facilities on a pilot basis.

The bill passed in the Assembly and cleared 2 Senate committees, but on September 12 it fell 2 votes short of the margin needed to pass in the full Senate.

"While I am disappointed that the bill will not pass at this time, I am committed to finding a way forward next year. The opioid epidemic continues and new solutions are desperately needed," Eggman said in a statement.

"For an issue that no one in Sacramento had ever heard about last year, the fact that we made it through four committees and one house this year was an amazing success," said Laura Thomas of the Drug Policy Alliance. "Fortunately, the delay in state legislation is not stopping San Francisco from doing the right thing and moving forward with supervised consumption services."

In San Francisco, the stickiest issue is likely to be where to locate safe injection sites, as new facilities are likely to arouse neighborhood opposition. The Tenderloin and South of Market areas currently have the highest burden of injection drug use and the most social services used by people who inject drugs, according to the report.

One prospect is the San Francisco AIDS Foundation's 6th Street harm reduction center, which currently offers sterile syringes and support services for people who use drugs.

"San Francisco is experiencing overdose at epidemic levels, and to reverse this horrifying trend we must respond to the overdose epidemic as a public health crisis, not as a criminal justice issue," said SFAF director of substance health services Mike Discepola. "San Francisco AIDS Foundation is one of the handful of organizations that currently operate syringe access and disposal sites where safe injection services could be piloted, and we're looking forward to working together at exploring what a pilot program could look like."

This would not be the first time San Francisco went forward with a harm reduction approach without legal backing. In the late 1980s, activists started one of the country's first unsanctioned needle exchanges, distributing safe injection supplies from a baby carriage. For years the Board of Supervisors declared a state of emergency on a monthly basis to circumvent the law.

"San Francisco has a long history of taking bold steps to expand progressive health policies, even when state and federal laws are far behind modern science and research," Wiener. "Supervised injection sites will mean fewer people injecting on our streets, fewer needles on our sidewalks, and more opportunities to get people into services and recovery programs."